Provider Demographics
NPI:1053487702
Name:WALDOBORO CHIROPRACTIC CENTER PA
Entity Type:Organization
Organization Name:WALDOBORO CHIROPRACTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-832-6347
Mailing Address - Street 1:PO BOX 625
Mailing Address - Street 2:
Mailing Address - City:WALDOBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04572-0625
Mailing Address - Country:US
Mailing Address - Phone:207-832-6347
Mailing Address - Fax:207-832-4664
Practice Address - Street 1:290 BREMEN RD
Practice Address - Street 2:
Practice Address - City:WALDOBORO
Practice Address - State:ME
Practice Address - Zip Code:04572-0625
Practice Address - Country:US
Practice Address - Phone:207-832-6347
Practice Address - Fax:207-832-4664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR875111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME129130100Medicaid
022301OtherANTHEM
MEMM9923Medicare PIN
T06443Medicare UPIN